Swine Flu Q & A

Maggie Koerth-Baker is a guest blogger on Boing Boing. A freelance science and health journalist, Maggie lives in Minneapolis, brain dumps on Twitter, and writes quite often for mental_floss magazine.

First off, I want to thank everybody who has contacted me on this. You've all had some great questions. I'm happy to report that I've been able to find answers for most of them. Hopefully, this information is useful--or, at least, educational for y'all.

Second, real quick, I want to clarify that, despite my fascination with viruses, I am not on their side. My heart goes out to the people in Mexico who have lost loved ones to this illness. I also sympathize with people here in the U.S. who are experiencing varying degrees of fear over this thing. I would much rather be talking about the science of viruses as a complete non-sequitur with no news hook at all. But, as the situation stands, I find that information (and, yes, a bit of humor) is the best way to tackle fear.

Now, without further ado, let's get on to the questions...

1. Various Inquiries About Cytokine Storm and Whether It's Going to Kill Us All
The name "cytokine storm" basically describes an over-reaction of a healthy immune system, that causes the body to attack itself. It can be triggered by many things, including viruses, although it's not common for human influenza A virus strains to cause it. Researchers suspect the cytokine storm effect played a roll in the 1918 flu pandemic, and may account for why that flu killed so many young adults, when normally, flu kills people with weak or underdeveloped immune systems: The very young, the old, the sick.

Based on the ages of many of the people dying in Mexico, there's been a lot of concern that the H1N1 swine flu virus is also killing via a cytokine storm effect, with the implication that this flu virus will be as deadly as the 1918 version. But, according to Andrew Pekosz, Ph.D, associate professor of microbiology and immunology at Johns Hopkins Bloomberg School of Public Health, it doesn't look like H1N1 swine flu is causing cytokine storms in its victims.

The most pressing concern with swine H1N1 is not its ability to cause more severe disease, it is its ability to infect large numbers of humans because we don't possess any immunity to this particular novel virus strain. With respect to Mexico, I don't know...nor does anyone as far as I can tell...how many mild disease cases can be attributed to swine H1N1. I suspect there are a lot, in which case the number of deaths (as a percentage of total number of infected people) would be comparable to what we see with seasonal flu. I have no doubt that people have died of respiratory disease in Mexico, but I think we need much more information about how many total cases there are before we can say how virulent the virus is.

In other words, unless information gathering later tells us otherwise, you probably don't need to worry about cytokine storm with this flu virus.

2. Concerning Those Little Surgical Masks...And Other Forms of Prevention
Surgical masks can aid prevention, but only to a point. Viruses can pass through standard surgical masks. You're better off using a specialty mask with the designation N-95 or N-99. Those are available online or at pharmacies. But even that's not perfect. The virus can live for up to 2 hours outside the human body and it's likely to be on any surface an infected person might touch after sneezing, or sneeze on directly. Desks, doorknobs, computers...lots of things. Hand-washing and keeping your hands away from your eyes and face (and, if you have the flu, staying away from everybody else) are still the best ways to prevent transmission.

And, about antiviral medications like tamiflu. Those drugs could, theoretically, work as a preventative measure. But, according to Christine Layton, a public health policy analyst with the North Carolina-based non-profit research institute RTI International, that would be a REALLY bad idea. She says:

Influenza (like other viruses) can become resistant to antiviral medication. When this occurs, antiviral medications are no longer effective. The best way to prevent the development of resistant viruses (or bacteria) is to use antiviral (or antibiotic) medications only when infected with a virus which will respond to the medication."

Another great way to keep from getting swine flu: Don't got to Mexico. The State Department has said that all unessential travel to the area should be avoided. Do what they say, here. Even if it ends up costing you some money on airline tickets, the risk of picking something up---and, perhaps worse, spreading it to family, friends, and everyone you share an airplane with---just isn't worth it. You don't want to be responsible for that.

3. What About the Symptoms and Which are Deadly?
You know how everything seems to start off feeling like the flu? This, too. In fact, the cases in the US have been, essentially, no different from a seasonal bout of flu, like those many of us have already had this year. You get a fever. Your nose runs. You feel like a truck hit you. Then you sleep for a couple of days, eat some saltines, drink some pickle juice*, and you're good.

Obviously, though, this scenario is going down differently south of the border. Some of you wanted to know what, exactly, the flu was doing to kill those people. I'm not having much luck tracking down specifics to these cases, but most likely, the H1N1 swine flu kills people in Mexico the same ways seasonal flu kills 36,000-odd Americans every year. Flu can interact with chronic illnesses (such as asthma or heart disease) to make the symptoms of those chronic diseases worse--sometimes fatally worse. A flu infection can also lead to pneumonia, which inflames the lining of the lungs and fills them up with fluid--making it difficult to breathe, and sometimes causing death. Dehydration from diarrhea, and brain damage from sustained very high fevers, can also kill flu victims.

Even if you do have flu symptoms, the chances of you having swine flu are pretty low, unless you've recently been to Mexico or spend a lot of time around someone who has. In that case, you should call your doctor, rather than going to the hospital or to her office. The best way to keep swine flu from spreading is to keep it away from the public.

And, finally, remember that it's allergy season. I've got a runny nose right now, but if there's no fever and you've still got the energy to go about your regular life, it's probably not the flu at all.

*Or is that just my family?

4. Will There Be a Vaccine?
Apparently, yes. But not anytime soon. Christine Layton tells me that there are companies working on a vaccine for H1N1 swine flu, but the lag time on vaccine production is pretty gnarly. We're talking 3-to-6 months before anything can get out the door, and that's with development and production being fast-tracked. Because flu viruses tend to pretty quick on the mutation draw, the "wild" virus will likely be different from the one the vaccine is modeled on by the time it comes out. That doesn't mean a vaccine won't work, though. Flu vaccines often work on a "close enough" principal. Basically, if the virus the vaccine is based on is similar enough to the wild virus, the vaccine can still help your body mount a defense. It may not prevent illness altogether, but the illness you get might be more mild that what you'd have come down with otherwise.

That said, there's also a distinct possibility that, by the time a vaccine is out, H1N1 swine flu won't be a problem anymore.

5. The $64,000 Question
Many people emailed to ask why a virus that appears to be killing people in Mexico is producing illness that barely warrants a trip to the doctor here. Baby, if I could answer that, my pay grade would be a LOT higher. This is really the big, central mystery right now. And while there is no shortage of speculation, the fact is that (as of this writing) nobody has any frackin' clue. There is, however, a World Health Organization science briefing scheduled for tomorrow. Maybe we'll get some preliminary answers then. But I wouldn't bet on it.

6. "I Have Taken The Amino Acid Sequence of H1N1 Swine Flu and Turned It Into a Piece of Ambient Music. Does This Interest You?"
Yes, Stephan Zielinski. Yes, it does. You can listen to Stephan's appropriately haunting, sad and beautiful composition on his Web site.

Finally, a quote to bear in mind, from Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, as reported by the (hopefully) immortal Canadian Press medical journalist Helen Branswell:

"Anybody who thinks they know what this virus is going to do weeks, months or years from now really doesn't have a clue what they're talking about."

It's possible to take this quote several ways. I choose to look at it hopefully. Let's take worst-case-scenarios--and the people promoting them--with a grain of salt for now.


  1. No, no, no, No!

    All this informed and rational discourse is a TRICK propagated to you sheeple by your Reptoid masters.

    Hand washing? HAH! You can’t spell “President Barrack Hussein Obama” without “DR BRONNER SOAP.” Coincidence? I think not!

    Only through panic, wild speculation, and spreading rumors by racist nut-jobs can we survive long enough to emerge from our prayer bunkers in a land cleansed of all those people we don’t like. NGHN!

  2. “Anybody who thinks they know what this virus is going to do weeks, months or years from now really doesn’t have a clue what they’re talking about.”

    Which is why I’m actually worried. Not panicking, just worried.

  3. “Scanning ‘Swine Flu Hemagglutinin.mp3’ for viruses…none found.”

    It’s resistant to virus checkers, too, apparently.

  4. Your entries are the first on this site that I’ve decided to always read. Thanks so much for writing them.

  5. Thank you for posting a well-rounded and rational discussion of swine flu. I’ve been looking for one for days.

  6. A guide to Masks — Types, Choosing (PPE) – http://ykalaska.wordpress.com/2006/04/13/masks-%e2%80%94-types-choosing-ppe/ is useful for understanding whether to protect others (breathing out, i.e., mask) or protect from others (breathing in, i.e., respirators).

    An alternate form, that I can’t yet get the state of Alaska or the university or the feds to test is an N-95 possible equivalent== http://totobobo.com

    This last one is easily fit tested (what good is a leaky mask or respirator) and can be fitted to almost any face– adult, child, European, Eskimo.

    Also–3 things everyone should know to prevent pandemic flu, MRSA, RSV, pink-eye

  7. I’m guessing the “pickle juice” thing is related to the use of cider vinegar as a home remedy, which may in fact be effective for some maladies, though I had not previously heard of it being used for the flu.

  8. Thanks for posting this stuff, and cutting through the crapfest that is “Deadly Swineflu Alert ’09” in the mainstream media.

    It is very frustrating that reports continue to insinuate “cytokine storm” by citing deaths in the 20-40 age group, yet there has been little or no follow up to confirm this. It does appear that incidence reporting coming out of Mexico for the last week has been sketchy and unreliable, and it seems crazy to base any kind of strategy to deal with this new flu on the chaotic data coming from Mexican authorities.

    CNN reports:”Mexico has reported 152 fatalities in flu-like cases in recent days, seven of which have been confirmed as swine flu.” ??? Hopefully CDC can get the real story down there.

    My guess for the disparity btwn US and Mexican deaths? 6-8 tons of fecal matter, chemicals, and other garbage floating around in their air at any given moment (Distrito Federal at least).

    Of course, the longer this bug floats around in the wild, the more likely it recombines or drifts into something different, which is scary.

  9. I’m no virologist but I’m a mexican girl who lives in Mexico city and for sure I know what’s going through most mexicans’ minds. See, people here in Mexico are soooo stubborn when it comes to going to the doctor. It’s like George Lopez said once “Mexicans don’t go to the doctor because they are afraid they will find something is wrong with them”. People don’t go to the doctor unless they are pretty much coughing blood or unable to walk. People are dying because they won’t go to the doctor, they are afraid of confirming what is evident. Worse than that is the fact that lots of people thing this is all a sick joke or some kind of distraction from the part of the government. They aren’t serious when it comes to taking care of themselves and think this is all Resident Evil or 28 Days Later.

    So that’s my theory why here in Mexico is much worse than in everywhere else.

  10. Here is an idea that I haven’t heard anyone mention. I wonder if some kind of intestinal parasite that is prevalent in mexico is altering the immune response of people so they can’t resist the infection.

    It is known that some parasites alter cell mediated immunity:


    It is also known that this is required to fight the flu:


    Also, nematodes can potentially infect people who eat raw fish (like Ceviche). Plus they have high infection rates for worm parasites in mexico:


    There are a lot more articles on these things I just pulled up the first ones I found so they may not be the best but it gets the idea across.

    Also, I bet back in the last flu pandemic in the early 20th century a lot more people had GI parasites.

  11. Thaaaaaaaaaank You!

    The media in Australia is running with this like its the apocolypse, but I’ve seen a few clips from the US that make our news look tame.

    Really nice to see a clear and concise explanation of central issues such as cytokine storm presented in a few hundred words. Hours of television news coverage consistently fails to manage this.

    I’ve been wondering why the Dreaded Swine Avian Flu of Death has arrived on our shores, but the actual things we fear about it haven’t.

    So has everyone else with a brain, apparently.

    I’ll throw in some wild speculation of my own, this virus could introduce swine and avian strains to the general population, and create immunity benefits and resistance to future hybrid flu strains.

    Note: I’ve got absolutely no qualifications to speculate on this, but that doesn’t seem to be a limiting factor anymore…

  12. I wouldn’t be surprised if pickle juice was chock full of electrolytes and other good things a dehydrated person might really need.

    Sure as hell it tastes better than Gatorade.

  13. Having lived in Minnesota for many years, I’ve heard Osterholm’s bleak prognostications over and over. Like any dedicated pessimist, he’s bound to be right one of these times, but most of us here have relegated him to the ‘cry wolf’ heap.

  14. Before we start freaking out, consider that, according to the CDC, plain old regular flu kills 36,000 people a year, every year. 36,000. So far less than 100 people have died at all of swine flu and NONE in the US.

    The MSM loves stories that generate fear and panic because it generates revenue.

    Turn off the TV and go play a game. The world won’t be ending any time soon.

  15. What I find remarkable about this is that the widespread publicity will almost certainly cause individuals and countries to take precautions which will contain or eliminate the threat. And then the pundits will decry scare-mongering because it didn’t turn out to be a disaster. Of course these same pundits would be the first to criticize the media and the governments if they didn’t alert the public.

    There’s a peculiar notion that infectious diseases that once plagued us just disappeared on their own. They didn’t. Polio and measles and cholera disappeared from the developed world because media and governments publicized them and individuals took appropriate precautions.

  16. Thanks for the update Maggie! Below is a note I received from a U.S. Nurse in Barra de Potosi, Mexico. I have received many emails regarding the coordinated efforts of local medical personnel and the health department to educate and warn citizens.

    Stefani greetings
    So you will know….
    Locally they have decided to close the schools until May 6. This is a safety measure….but it was also a time of a lot of holidays so it not a big move.
    Everyone is very calm. Public health announcements are sane and well coordinated.
    People continue to be much more concerned about the lack of jobs and the down turn in the economy. Money from Mexican workers in the US has decreased substantially and tourism is very low.
    Otherwise life is the same….. locally there is no 24 hour news, no talk shows, no constant onslaught of threats….and nothing interferes with the constant stream of novellas that grip the population throughout the day.
    Thanks for your concern

  17. Antinous – I agree completely with your statements. I work at a research institute with heaps of PhD and Master’s students as well as career researchers. I’ve heard a few people here mention that swine flu is all a big media invention. These people are supposed to be smart – I pointed out the millions of people who died of Spanish flu in 1918.

    I suspect that people in Western societies are just too comfortable and can’t imagine life being anything other than how it is now. Short-sighted yes, but I suspect it’s pretty fundamental to human nature.

  18. Ill Lich:

    I just bought an older book of herbal remedies (they’re really interesting reads), I looked up flu remedies and preventatives.

    Something to take as flu sets in contains cider vinegar, water, sea salt(lots of nutrients) and cayenne pepper. You take a wee bit every half hour.
    Dill also has a calming effect on the stomach. But I don’t know about juice from a jar.

    Maggie, what kind of pickle was it?

    BTW – I’ve been mentioning the fact that we don’t know about the mild Mexican cases for a few days…not many people seem to understand.
    Also, there was a new conference from Canada, one of the guys on it (forgot title…) said that they might be able to have a vaccine out to front line workers in as little as 2 months…if things go well.

  19. resident evil ps3 has a crap plot,the story is weak as and is missing its whole outbreak theme,this should boost sales,sheva stands for spread havoc everyones virus anywhere,anyone who is stuck indoors gets killed with boredom.the pigs are our relatives probably secret cloning gone wrong but pigsy is a hero for helping monkey realise that we look the same to him hhhhhnn ah pigsy

  20. In regards to the “scare-mongering” leading to positive results – this is true , up to a certain point. The people who need to be spurred to action during this kind of event are those who do not, and maybe can not, really understand the threat. By splashing DEADLY FLU OMG all over the news, you can actually reach these folks and get them to do the right things.

    Of course, this will only work once or twice until those same people will cease believing the headlines and then there is a problem, similar to what #20 posted – many Mexicans apparently don’t believe anything their government tells them now, which leads to bigger problems when the government needs to inform, and motivate the public.

    Hopefully, this flu dwindles down, and leaves us with a nice trial run with which we can fine tune our global response to future outbreaks.

  21. cowards:
    A mother pig was walking through the barnyard one day with one of her
    piglets. Suddenly, a raccoon raced out from behind the barn and scared
    the living daylights out of the mother pig. The little hog laughed to
    see such a plight and the sow jumped over the coon.

  22. no prisoners!

    A traveler was driving through Arkansas when he lost his way and got off the main highway. As he drove by, he saw rows and rows of pigsties and pigpens and pigs running in fields and pigs wallowing in mud. Suddenly, his eye caught something really strange. He did a double take, muttered to himself and then looked a third time. He wondered if he had seen correctly – it looked like a pig with a wooden leg!

    He found the lane to the farm and drove up into the farmyard, where he was met by the farmer. “Excuse me,” the traveler said. “I was just driving by and looking at all your pigs, and I noticed something that I just had to stop and ask about. Tell me, did I see right? Is there really a pig out there with a wooden leg?” The farmer smiled. “Oh, that would be old Caesar you saw. He’s the finest pig a man could ever hope to have – and smart! Well, let me tell you a little about that pig. You see that barge down there on the river? That’s a mining dredge, taking out platinum ore. Old Caesar sniffed out the vein and showed us how to set it up. Now that dredge brings me in about $120,000 every year.

    “There’s another thing, too, a little more personal. One night a couple of years ago I got to drinking and I guess I had more than I should have. I passed out drunk, fell down and knocked over a lamp. That started a fire in the house and old Caesar smelled the smoke. He came in the back door, got the wife and kid out, roused me up and got me out. “There is no question about it – that night old Caesar saved all our lives and you know that is not the sort of thing a man is going to forget too easily.”

    “Why,” the traveler said, “this is all amazing! I have never heard of a pig like this before! This is fantastic! But tell me, how did he get that wooden leg? Was he in a wreck or something?”

    The farmer laughed and said, “Well, naturally, when you have a pig that smart, you don’t want to eat him all at one time!”

  23. Antinous,

    I agree to an extent. We have large stockpiles of anti-virals in Australia due entirely to the media speculation about bird flu.

    However, surely you must have noticed how hard it is to get a quick summary of the facts, as presented here, through the news networks?

    Its all rolling death tolls, experts predicting 20% of the planet will die, and pictures of people with face masks.

    The Daily Show had a very telling clip from a government press conference, went something like this:
    Reporter: Is there any intelligence suggesting this virus has been generated by terrorists?
    Expert: No. This outbreak is completely consistent with natural virus behaviour.
    Reporter: But you wouldn’t completely rule out terrorist involvement?

    Headline: Government refuses to rule out terrorist involvement in swine flu pandemic!!!!

    It would just be nice to see some balance. We’ll have used up all the damn Tamiflu by the end of the week the way we’re going…

  24. you will pray for the release of death!

    A lawyer a Rabbi and a Hindu holy man, had car trouble in the countryside and asked to spend the night with a farmer.
    The farmer said “There might be a problem; you see, I only have room for two to sleep, so one of you must sleep in the barn.”

    “No problem,” chimed the Rabbi, “My people wandered in the desert for forty years, I am humble enough to sleep in the barn for an evening. With that he departed to the barn and the others bedded down for the night. Moments later a knock was heard at the door; the farmer opened the door, there stood the Rabbi from the barn. “What’s wrong?” asked the farmer. The Rabbi replied, “I am grateful to you, but I can’t sleep in the barn. There is a pig in the barn and my faith believes that this is an unclean animal.”

    His Hindu friend agrees to swap places with him. But a few minutes later the same scene reoccurs. There is a knock on the door, “What’s wrong, now?” the farmer asks. The Hindu holy man replies, “I too am grateful for your helping us out but there is a cow in the barn and in my country cows are considered sacred. I can’t sleep on holy ground!”

    Well, that leaves only the lawyer to make the change. He grumbled and complained, but went out to the barn. Yep, you guessed it! Moments later there was another knock on the farmers door. Frustrated and tired, the farmer opens the door, and there stood the pig and the cow.

  25. A man is driving up a steep, narrow mountain road. A woman is driving down the same road. As they pass each other, the woman leans out of the window and yells “PIG!”

    The man immediately leans out of his window and replies, “BITCH!”

    They each continue on their way, and as the man rounds the next corner, he crashes into a pig in the middle of the road and dies.

    If only men would listen.

    1. Best Guest Blogger ever! Timing is everything.

      She hasn’t even caused a plane to crash into the Hudson yet.

  26. Stephan Zielinski FTW on remix culture! I’m loading it on my iPod for tomorrow’s plane flight.

    I wonder what smallpox sounds like?

  27. Hmm, I like pickle juice too, but I never thought of it as a home remedy… just the treat you got when you took the last pickle. :)

  28. My guess is that if this flu started in Mexico, they have a head start on everyone and we will see whatever happens in Mexico play out in other parts of the world, but on a smaller scale, due to the reduced geometry of contact. So there will be some death cascades here and there with the same death to infection ratio as in Mexico, but less total numbers.
    This is already unexpected and of course it is unknown what the virus will do. Watch what happens there, put a delay on it, and here it comes.

  29. Viruses, bacteria and fungi do not cause diseases. Humans cause diseased by the choices they make in their lives. This also includes choices made by ancestory and expressed as genetics. Why worry about something you have complete control over? You create your own reality and the worry is gonna kill you anyway.

    1. Viruses, bacteria and fungi do not cause diseases.

      No, really. Disease is spread by miasma. Here, have some water that I just decanted from the cesspool.

  30. Dr. Michael Osterholm has been consistently wrong for decades. Whenever the media here trots him out blaring his alarmism I turn him off. He only has one product that he’s selling and that’s his own self aggrandizement.

    Of course, he is careful not to say anything factually wrong. He just pushes the worse case scenario and engages in hyperbole in order to promote his own career.

    I think there is a lot of that going around.

  31. Aw man, Maggie, you’re the best guest blogger BB has had in a loooong time.

    Xeni, Cory, Mark et al – could we consider having Maggie as a permanent blogger?

    Or could she at least come round my house for tea and biscuits some time?

  32. You know, it’s worth pointing out that air pollution in Mexico City is really, really, REALLY bad. I’m no doctor, but it doesn’t seem too far-fetched to me to think that a nasty case of the flu could push someone over the edge there.

  33. Having proper levels of vitamin D may help if you get any influenza. Look it up and get some sun.

  34. Hey, I remember getting immunized against some form of swine flu in college, as part an aggregate flu vaccine. That was at least three years ago though. Is there any possibility that I will be immune to this virus?

  35. What is the possibility of the altitude and pollution factors being if not significant but contributory issues with the number of deaths in Mexico city?

  36. No, I’d offer to buy the house. The price drops the longer they wait, of course.


    I think @20 Florsie has it right. It’s way too early to establish demographics on the deaths in Mexico, but chances are most of the victims in Mexico are working or poor. Machismo may play a role also, but a visit to the doctor entails at least the opportunity cost of missing a day’s work (or the risk of being fired), and of course the possibility of learning about an expensive illness.

    A lot of people in Mexico City went to work yesterday although the mayor advised against travel, because that’s not the same as permission from one’s boss to throw a sickie at the first sniffle.

    For most of us reading this, getting the flu sucks, but you can call in sick without being fired, grab the aspirin bottle, fix some ramen or chicken soup (or dill juice), and wait it out. Being upper-working class has its advantages.

    If this is true, then the relatively high number of deaths in Mexico is not much different from that in China with bird flu.

    It also suggests that the flu will spread amonf working-class US citizens pretty quickly, though to less deadly effect, and of course adjusting for the benefit of early warning from Mexico.

    My 2 centavos, anyway.

  37. Taliban s in the desert,
    Tsunamies in the sea;
    vises in the atmosphere;
    Quakes in the crust……

    The END TIME is around, ever herd of Apocalypse ?.
    Receive your baptism in Christ NOW!!!!!!!!!!!!


  38. So like, I’ve been sneezing, but I usually sneeze this time of year because of pollen. I’m wondering if I should be avoiding other people just in case it’s more than just allergies.

  39. RE: “5. the $64,000 Question:

    Many people emailed to ask why a virus that appears to be killing people in Mexico is producing illness that barely warrants a trip to the doctor here. Baby, if I could answer that, my pay grade would be a LOT higher.”


    Incidentally, the 25 to 45 age fatality range came from a National Public Radio correspondent quoting official Mexican government medical sources.

    Now, we can all debate NPR’s reliability right along with ABCCBSNBCFAUXNEWS, and TASS (not to mention the illustrious Mexican government) but either the statistic is true or not, and if it is true, that is NOT a good sign people…

  40. i live in California i dont have health insurance i think i could have the swine flu . if not getting treated will the our bodies fight off the flu by itself ? it could i get worse

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